http://www.fpnotebook.com/

TeriparatideAka: Forteo

Mechanism
1. Recombinant Parathyroid Hormone
2. Significant bone anabolic activity
Indications: Severe Osteoporosis
1. Women, postmenopausal, with severe bone loss
2. Men with Osteoporosis and high risk of Fracture
3. Osteoporosis refractory to Bisphosphonates
Dose
1. Teriparatide 20 mcg SQ daily for up to 2 years
2. Consider restarting bisphosphonate after Teriparatide course is completed
  1. Black (2005) N Engl J Med 353(6):555
Efficacy
1. BMD increases 5.9% at spine and 1.5% at femoral neck
2. Reduced risk for osteoporotic Fractures
  1. Neer (2001) N Engl J Med 344:1434
Contraindications
1. Hyperparathyroidism
2. Osteomalacia
3. End Stage Renal Disease
4. Bone cancer
5. Active Nephrolithiasis
6. Hypercalcemia
7. Osteosarcoma risk
  1. Paget's Disease
  2. Prior skeletal radiation
  3. Elevated Alkaline Phosphatase level
Adverse Effects
1. Common
  1. Orthostatic Hypotension
  2. Transient Hypercalcemia
  3. Nausea
  4. Arthralgia
  5. Leg cramps
2. Uncommon (identified in rat studies)
  1. Osteosarcoma
Precautions
1. Do not use with bisphosphonate
2. Use limited to 2 year maximum
Resources
1. National Osteoporosis Foundation Clinicians Guide To Osteoporosis
  1. http://www.nof.org/professionals/Clinicians_Guide.htm
References
1. Campion (2003) Am Fam Physician 67(7):1521
2. Orwoll (2003) J Bone Miner Res 18:9

Teriparatide (C0070093)
Definition (MSH)	A polypeptide that consists of the 1-34 amino-acid fragment of human PARATHYROID HORMONE, the biologically active N-terminal region. The acetate form is given by intravenous infusion in the differential diagnosis of HYPOPARATHYROIDISM and PSEUDOHYPOPARATHYROIDISM. (Reynolds JEF(Ed): Martindale: The Extra Pharmacopoeia (electronic version). Micromedex, Inc, Englewood, CO, 1995)
Concepts	Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
MSH	D019379
English	HPTH 001 034, Teriparatide, TERIPARATIDE @ @ UNIDENTIFIED, TERIPARATIDE PREPARATION, TERIPARATIDE UNIDENTIFIED
Spanish	teriparatida, teriparatide
Parent Concepts	Parathyroid Hormones (C0030520), Recombinant Growth Factor (C1515377), Parathyroid gland (C0030518), [DX900] DIAGNOSTICS, OTHER (C0973537), Unclassified Ingredients (C1372954), Diagnostic agents (C0358514), Polypeptides (C1305923), Calcium regulating hormone (C0360589)
Sources	MSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF Derived from the NIH UMLS (Unified Medical Language System)

Forteo (C1170286)
Concepts	Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
MSH	D019379
English	Forteo, Lilly Brand of Teriparatide, Teriparatide Lilly Brand
Sources	MSH, RXNORM Derived from the NIH UMLS (Unified Medical Language System)